Osteitis Pubis

Original Editor - Shreya Pavaskar
Top Contributors - Tehseen Zahra, Lucinda hampton, Pacifique Dusabeyezu, Kim Jackson, Shreya Pavaskar and Aminat Abolade

Description

Osteitis pubis is chronic condition affecting the pubic symphysis and surrounding soft tissues. It is characterized by pain and local tenderness over the pubic symphysis. It commonly affects athletes, especially those who participate in sports that involve kicking, turning, twisting, cutting, pivoting, sprinting, rapid acceleration and deceleration or sudden directional changes. It is an overuse syndrome.

Clinically Relevant Anatomy

The pubic symphysis is a fibro-cartilaginous, non-synovial amphiarthrodial joint between left and right superior rami of the pubic bones. It is located in front of and below the urinary bladder. The center is avascular in nature. The ends of both pubic bones are covered by hyaline cartilage attached to the fibrocartilage. The fibro-cartilaginous disk is reinforced by ligaments. Adductor longus, Gracilis, Adductor brevis, Obturator externus and rectus abdominus muscles attach to pelvis.

Mechanism of Injury

The exact etiology is not exactly been clarified and is still debated. Muscle imbalance between the abdominal and hip adductor muscles is currently considered the most important pathogenetic factor in the development of osteitis pubis. The adductors are antagonists to the abdominal muscles. Imbalances between abdominal and adductor muscle groups disrupt the equilibrium of forces around the pubic symphysis, predisposing the athlete to a subacute periostitis caused by chronic microtrauma. The cumulative microtrauma and altered biomechanics leads to instability and lesions. Reduced internal rotation of the hip, pregnancy, rheumatic disorders and instability of the sacroiliac joint predisposing factors as they lead to increased shearing stress in the pelvis.

Clinical Presentation

-  Anterior and medial groin pain exaggerated by movement

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Diagnostic Procedures

Plain Radiographs can be helpful in diagnosis of later stages and rule out other sources of groin pain. Radiographic changes may be present in chronic stages A Flamingo view (an anterior posterior view of the pelvis with patient standing on one leg) can give evidence of pelvic instability as a vertical subluxation greater than 2 mm or greater than 7 mm widening of symphysis are considered pathognomonic. A MRI can be used for detailed examination and may reveal edema. Bone scintigraphy may reveal increased tracer uptake in the pubic symphysis region

Medical Management

Osteitis Pubis is usually self limiting usually improving with rest, ice and limited activity. Conservative treatment is beneficial and symptoms resolve spontaneously along with rest anti-inflammatory drugs are given to reduce inflammation. Other treatments include oral or injected corticosteroid and local anesthetics in the same region and surrounding tissues or dextrose prolotherapy however there limited evidence. Surgical management is done if treatment fails after 3 months of conservative management. All procedures can be associated adductor tendon release or with adductor enthesis repair Some authors suggested endoscopic pubic symphysectomy.

Differential Diagnosis

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Resources

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References

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